09-26-2010, 07:38 AM
USMLE CK : Sleep Disorders
Sleep Disorders
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Characteristics:
Narcolepsy
Excessive daytime sleepiness and abnormalities of REM sleep for a period of greater than 3 months
REM sleep occurs in less than 10 minutes. Patients will feel refreshed upon awakening
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Clinical Features:
Narcolepsy
Sleep attacks
Cataplexy
Hypnagogic and hypnopompic hallucinations
Sleep paralysis
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Management:
Narcolepsy FORCED NAP AT REGULAR TIME OF DAY
Pharmacotherapy (psychostimulants for sleep attacks and imipramine for cataplexy)
ANTIDEPRESSANTS FOR CATAPLEXY
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Characteristics:
Sleep Apnea
Cessation of air flow at the nose or mouth during sleep
Apneic episodes usually last greater than 10 seconds each
Loud snore followed by a heavy pause Usually seen in obese, middle aged males, who complain of being tired during the day
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Clinical Features:
Sleep Apnea
Types
o obstructive MS ATONY IN OROPHARYNX
o central LACK RSP EFFORT
o mixed
Complications
oArrhythmias
o pulmonary hypertension
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Management:
Sleep Apnea
Nasal continuous positive airway pressure
Weight loss
Surgery
Treat the underlying condition
________________________________________
Case Study
Case #1 A 45-year-old housewife is being seen at a sleep clinic for the first time. She claims that she has been unable to sleep for the last few years. According to the patient, her obese, middle-aged husband™s œsnoring keeps her up all night and interferes with her sleep.
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Case Study
Case #2 A 50-year-old businessman is seeking help to overcome his being œtired during the day. He has taken vitamins during the last few months since he thought theymight help. He is 54 and weighs 200 pounds.
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INSOMNIA
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Characteristics:
Difficulty in initiating or maintaining sleep
Underlying pschiatric disosrder : Depression [ more often in women] PTSD, OCD and eating disorder
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Clinical Features:
Difficulty initiating and maintaining sleep
level of functionning is affected
yawning and tiredness during daytime
________________________________________
Management:
Good sleep hygiene techniques
Avoid evening stimulation
if med , Benzodiazepines for a short period of time
________________________________________
Diff Diag:
Medical : Pain CNS lesions, Endocrine , Environmental changes Etoh diet medications
Psychiatric: Anxiety Depression
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PARASOMNIAS
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NIGHTMARES
SLEEP STAGE: REM
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Characteristics
memory of event at awakening & increased during time of stress
he denies any suicidal ideation or plan.
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Management
REM SUPPRESSant: TCAs
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SLEEP WAKING
SLEEP STAGE STAGE 3 & 4
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Sequence of behaviors of perversive behavior WITHOUT FULL CONCIOUSNESS .. TERMINATING wthout ANY MEMORY OF THE EVENT.. Exacerbate by SLEEP DEPRIVATION
------------------------------------------------------------------------------------------MANAGEMENT
assure patient safety
stages 3 7 4 suppressant ; BENZODIAZEPINES
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NIGHT TERROR
Awakening by scream or intense anxity
No memory of the following event
--------------------------------------------------------------------------------
no treatment if needed consider BENZODIAZEPINES
......................................................................................................................
SLEEP TALKING
Sleep Disorders
________________________________________
Characteristics:
Narcolepsy
Excessive daytime sleepiness and abnormalities of REM sleep for a period of greater than 3 months
REM sleep occurs in less than 10 minutes. Patients will feel refreshed upon awakening
________________________________________
Clinical Features:
Narcolepsy
Sleep attacks
Cataplexy
Hypnagogic and hypnopompic hallucinations
Sleep paralysis
________________________________________
Management:
Narcolepsy FORCED NAP AT REGULAR TIME OF DAY
Pharmacotherapy (psychostimulants for sleep attacks and imipramine for cataplexy)
ANTIDEPRESSANTS FOR CATAPLEXY
________________________________________
Characteristics:
Sleep Apnea
Cessation of air flow at the nose or mouth during sleep
Apneic episodes usually last greater than 10 seconds each
Loud snore followed by a heavy pause Usually seen in obese, middle aged males, who complain of being tired during the day
________________________________________
Clinical Features:
Sleep Apnea
Types
o obstructive MS ATONY IN OROPHARYNX
o central LACK RSP EFFORT
o mixed
Complications
oArrhythmias
o pulmonary hypertension
________________________________________
Management:
Sleep Apnea
Nasal continuous positive airway pressure
Weight loss
Surgery
Treat the underlying condition
________________________________________
Case Study
Case #1 A 45-year-old housewife is being seen at a sleep clinic for the first time. She claims that she has been unable to sleep for the last few years. According to the patient, her obese, middle-aged husband™s œsnoring keeps her up all night and interferes with her sleep.
________________________________________
Case Study
Case #2 A 50-year-old businessman is seeking help to overcome his being œtired during the day. He has taken vitamins during the last few months since he thought theymight help. He is 54 and weighs 200 pounds.
________________________________________
INSOMNIA
________________________________________
Characteristics:
Difficulty in initiating or maintaining sleep
Underlying pschiatric disosrder : Depression [ more often in women] PTSD, OCD and eating disorder
________________________________________
Clinical Features:
Difficulty initiating and maintaining sleep
level of functionning is affected
yawning and tiredness during daytime
________________________________________
Management:
Good sleep hygiene techniques
Avoid evening stimulation
if med , Benzodiazepines for a short period of time
________________________________________
Diff Diag:
Medical : Pain CNS lesions, Endocrine , Environmental changes Etoh diet medications
Psychiatric: Anxiety Depression
________________________________________
PARASOMNIAS
________________________________________
NIGHTMARES
SLEEP STAGE: REM
________________________________________
Characteristics
memory of event at awakening & increased during time of stress
he denies any suicidal ideation or plan.
________________________________________
Management
REM SUPPRESSant: TCAs
___________________________________________
SLEEP WAKING
SLEEP STAGE STAGE 3 & 4
-----------------------------------------------------------
Sequence of behaviors of perversive behavior WITHOUT FULL CONCIOUSNESS .. TERMINATING wthout ANY MEMORY OF THE EVENT.. Exacerbate by SLEEP DEPRIVATION
------------------------------------------------------------------------------------------MANAGEMENT
assure patient safety
stages 3 7 4 suppressant ; BENZODIAZEPINES
--------------------------------------------------------------------------------------
NIGHT TERROR
Awakening by scream or intense anxity
No memory of the following event
--------------------------------------------------------------------------------
no treatment if needed consider BENZODIAZEPINES
......................................................................................................................
SLEEP TALKING